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Mohammadi S, Ghaderi S, Sayehmiri F, Fathi M. Quantitative susceptibility mapping for iron monitoring of multiple subcortical nuclei in type 2 diabetes mellitus: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2024; 15:1331831. [PMID: 38510699 PMCID: PMC10950952 DOI: 10.3389/fendo.2024.1331831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
Introduction Iron accumulation in the brain has been linked to diabetes, but its role in subcortical structures involved in motor and cognitive functions remains unclear. Quantitative susceptibility mapping (QSM) allows the non-invasive quantification of iron deposition in the brain. This systematic review and meta-analysis examined magnetic susceptibility measured by QSM in the subcortical nuclei of patients with type 2 diabetes mellitus (T2DM) compared with controls. Methods PubMed, Scopus, and Web of Science databases were systematically searched [following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines] for studies reporting QSM values in the deep gray matter (DGM) regions of patients with T2DM and controls. Pooled standardized mean differences (SMDs) for susceptibility were calculated using fixed-effects meta-analysis models, and heterogeneity was assessed using I2. Sensitivity analyses were conducted, and publication bias was evaluated using Begg's and Egger's tests. Results Six studies including 192 patients with T2DM and 245 controls were included. This study found a significant increase in iron deposition in the subcortical nuclei of patients with T2DM compared to the control group. The study found moderate increases in the putamen (SMD = 0.53, 95% CI 0.33 to 0.72, p = 0.00) and dentate nucleus (SMD = 0.56, 95% CI 0.27 to 0.85, p = 0.00) but weak associations between increased iron levels in the caudate nucleus (SMD = 0.32, 95% CI 0.13 to 0.52, p = 0.00) and red nucleus (SMD = 0.22, 95% CI 0.00 0.44, p = 0.05). No statistical significance was found for iron deposition alterations in the globus pallidus (SMD = 0.19; 95% CI -0.01 to 0.38; p = 0.06) and substantia nigra (SMD = 0.12, 95% CI -0.10, 0.34, p = 0.29). Sensitivity analysis showed that the findings remained unaffected by individual studies, and consistent increases were observed in multiple subcortical areas. Discussion QSM revealed an increase in iron in the DGM/subcortical nuclei in T2DM patients versus controls, particularly in the motor and cognitive nuclei, including the putamen, dentate nucleus, caudate nucleus, and red nucleus. Thus, QSM may serve as a potential biomarker for iron accumulation in T2DM patients. However, further research is needed to validate these findings.
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Affiliation(s)
- Sana Mohammadi
- Department of Medical Sciences, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sadegh Ghaderi
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Sayehmiri
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Mobina Fathi
- Student Research Committee, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Zhu Z, Naji N, Esfahani JH, Snyder J, Seres P, Emery DJ, Noga M, Blevins G, Smyth P, Wilman AH. MR Susceptibility Separation for Quantifying Lesion Paramagnetic and Diamagnetic Evolution in Relapsing-Remitting Multiple Sclerosis. J Magn Reson Imaging 2024. [PMID: 38308397 DOI: 10.1002/jmri.29266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Multiple sclerosis (MS) lesion evolution may involve changes in diamagnetic myelin and paramagnetic iron. Conventional quantitative susceptibility mapping (QSM) can provide net susceptibility distribution, but not the discrete paramagnetic and diamagnetic components. PURPOSE To apply susceptibility separation (χ separation) to follow lesion evolution in MS with comparison to R2 */R2 ' /QSM. STUDY TYPE Longitudinal, prospective. SUBJECTS Twenty relapsing-remitting MS subjects (mean age: 42.5 ± 9.4 years, 13 females; mean years of symptoms: 4.3 ± 1.4 years). FIELD STRENGTH/SEQUENCE Three-dimensional multiple echo gradient echo (QSM and R2 * mapping), two-dimensional dual echo fast spin echo (R2 mapping), T2 -weighted fluid attenuated inversion recovery, and T1-weighted magnetization prepared gradient echo sequences at 3 T. ASSESSMENT Data were analyzed from two scans separated by a mean interval of 14.4 ± 2.0 months. White matter lesions on fluid-attenuated inversion recovery were defined by an automatic pipeline, then manually refined (by ZZ/AHW, 3/25 years' experience in MRI), and verified by a radiologist (MN, 25 years' experience in MS). Susceptibility separation yielded the paramagnetic and diamagnetic susceptibility content of each voxel. Lesions were classified into four groups based on the variation of QSM/R2 * or separated into positive/negative components from χ separation. STATISTICAL TESTS Two-sample paired t tests for assessment of longitudinal differences. Spearman correlation coefficients to assess associations between χ separation and R2 */R2 ' /QSM. Significant level: P < 0.005. RESULTS A total of 183 lesions were quantified. Categorizing lesions into groups based on χ separation demonstrated significant annual changes in QSM//R2 */R2 ' . When lesions were grouped based on changes in QSM and R2 *, both changing in unison yielded a significant dominant paramagnetic variation and both opposing yielded a dominant diamagnetic variation. Significant Spearman correlation coefficients were found between susceptibility-sensitive MRI indices and χ separation. DATA CONCLUSION Susceptibility separation changes in MS lesions may distinguish and quantify paramagnetic and diamagnetic evolution, potentially providing additional insight compared to R2 * and QSM alone. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ziyan Zhu
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Nashwan Naji
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Javad Hamidi Esfahani
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Jeff Snyder
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Peter Seres
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Derek J Emery
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Michelle Noga
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Gregg Blevins
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Penelope Smyth
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Alan H Wilman
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
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Madden DJ, Merenstein JL. Quantitative susceptibility mapping of brain iron in healthy aging and cognition. Neuroimage 2023; 282:120401. [PMID: 37802405 PMCID: PMC10797559 DOI: 10.1016/j.neuroimage.2023.120401] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/14/2023] [Accepted: 09/30/2023] [Indexed: 10/10/2023] Open
Abstract
Quantitative susceptibility mapping (QSM) is a magnetic resonance imaging (MRI) technique that can assess the magnetic properties of cerebral iron in vivo. Although brain iron is necessary for basic neurobiological functions, excess iron content disrupts homeostasis, leads to oxidative stress, and ultimately contributes to neurodegenerative disease. However, some degree of elevated brain iron is present even among healthy older adults. To better understand the topographical pattern of iron accumulation and its relation to cognitive aging, we conducted an integrative review of 47 QSM studies of healthy aging, with a focus on five distinct themes. The first two themes focused on age-related increases in iron accumulation in deep gray matter nuclei versus the cortex. The overall level of iron is higher in deep gray matter nuclei than in cortical regions. Deep gray matter nuclei vary with regard to age-related effects, which are most prominent in the putamen, and age-related deposition of iron is also observed in frontal, temporal, and parietal cortical regions during healthy aging. The third theme focused on the behavioral relevance of iron content and indicated that higher iron in both deep gray matter and cortical regions was related to decline in fluid (speed-dependent) cognition. A handful of multimodal studies, reviewed in the fourth theme, suggest that iron interacts with imaging measures of brain function, white matter degradation, and the accumulation of neuropathologies. The final theme concerning modifiers of brain iron pointed to potential roles of cardiovascular, dietary, and genetic factors. Although QSM is a relatively recent tool for assessing cerebral iron accumulation, it has significant promise for contributing new insights into healthy neurocognitive aging.
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Affiliation(s)
- David J Madden
- Brain Imaging and Analysis Center, Duke University Medical Center, Box 3918, Durham, NC 27710, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA; Center for Cognitive Neuroscience, Duke University, Durham, NC 27708, USA.
| | - Jenna L Merenstein
- Brain Imaging and Analysis Center, Duke University Medical Center, Box 3918, Durham, NC 27710, USA
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Si L, Wang Z, Li XY, Song Y, Yao T, Xu E, Wang X, Wang C. Novel mutations and molecular pathways identified in patients with brain iron accumulation disorders. Neurogenetics 2023; 24:231-241. [PMID: 37453004 DOI: 10.1007/s10048-023-00725-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
Brain iron accumulation disorders (BIADs) are a group of diseases characterized by iron overload in deep gray matter nuclei, which is a common feature of neurodegenerative diseases. Although genetic factors have been reported to be one of the etiologies, much more details about the genetic background and molecular mechanism of BIADs remain unclear. This study aimed to illustrate the genetic characteristics of BIADs and clarify their molecular mechanisms. A total of 84 patients with BIADs were recruited from April 2018 to October 2022 at Xuanwu Hospital. Clinical characteristics including family history, consanguineous marriage history, and age at onset (AAO) were collected and assessed by two senior neurologists. Neuroimaging data were conducted for all the patients, including cranial magnetic resonance imaging (MRI) and susceptibility-weighted imaging (SWI). Whole-exome sequencing (WES) and capillary electrophoresis for detecting sequence mutation and trinucleotide repeat expansion, respectively, were conducted on all patients and part of their parents (whose samples were available). Variant pathogenicity was assessed according to the American College of Medical Genetics and Association for Molecular Pathology (ACMG/AMP). The NBIA and NBIA-like genes with mutations were included for bioinformatic analysis, using Gene Ontology (GO) annotation and Kyoto Encyclopedia of Genes and Genome (KEGG). GO annotation and KEGG pathway analysis were performed on Metascape platform. In the 84 patients, 30 (35.7%) were found to carry mutations, among which 20 carried non-dynamic mutations (missense, stop-gained, frameshift, inframe, and exonic deletion) and 10 carried repeat expansion mutations. Compared with sporadic cases, familial cases had more genetic variants (non-dynamic mutation: P=0.025, dynamic mutation: P=0.003). AAO was 27.85±10.42 years in cases with non-dynamic mutations, which was significantly younger than those without mutations (43.13±17.17, t=3.724, P<0.001) and those with repeated expansions (45.40±8.90, t=4.550, P<0.001). Bioinformatic analysis suggested that genes in lipid metabolism, autophagy, mitochondria regulation, and ferroptosis pathways are more likely to be involved in the pathogenesis of BIADs. This study broadens the genetic spectrum of BIADs and has important implications in genetic counselling and clinical diagnosis. Patients diagnosed as BIADs with early AAO and family history are more likely to carry mutations. Bioinformatic analysis provides new insights into the molecular pathogenesis of BIADs, which may shed lights on the therapeutic strategy for neurodegenerative diseases.
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Affiliation(s)
- Lianghao Si
- Department of Neurology & Neurobiology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
| | - Zhanjun Wang
- Department of Neurology & Neurobiology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
| | - Xu-Ying Li
- Department of Neurology & Neurobiology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
| | - Yang Song
- Department of Neurology & Neurobiology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
| | - Tingyan Yao
- Department of Neurology & Neurobiology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
| | - Erhe Xu
- Department of Neurology & Neurobiology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
| | - Xianling Wang
- Department of Neurology & Neurobiology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
| | - Chaodong Wang
- Department of Neurology & Neurobiology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China.
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Wang H, Chai C, Wu G, Li J, Zhao C, Fu D, Zhang S, Wang H, Wang B, Zhu J, Shen W, Xia S. Cerebral blood flow regulates iron overload in the cerebral nuclei of hemodialysis patients with anemia. J Cereb Blood Flow Metab 2023; 43:749-762. [PMID: 36545834 PMCID: PMC10108183 DOI: 10.1177/0271678x221147363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/16/2022] [Accepted: 10/09/2022] [Indexed: 12/24/2022]
Abstract
Hemodialysis patients exhibit anemia-related cerebral hyperperfusion and iron deposition (ID). However, the mechanisms underlying the pathology of cerebral ID are not clear. We investigated the role of cerebral blood flow (CBF) in the pathophysiology of cerebral ID in hemodialysis patients with anemia. This study recruited 33 hemodialysis patients with anemia and thirty-three healthy controls (HCs). All the subjects underwent quantitative susceptibility mapping (QSM) and arterial spin labeling (ASL) to measure ID and CBF in the cerebral nuclei. Furthermore, we evaluated lacunar infarction (LI), cerebral microbleeds, and total white matter hyperintensity volume (TWMHV). Hemodialysis patients with anemia showed significantly higher ID and CBF in some nuclei compared to the HCs after adjusting for age, sex, and total intracranial volume (TIV) [P < 0.05, false discovery rate (FDR) corrected]. CBF showed a positive correlation with ID in both patients and HCs after adjustments for age, gender, and TIV (P < 0.05, FDR corrected). Serum phosphorus, calcium, TWMHV, hypertension, and dialysis duration were independently associated with ID (P < 0.05). Hemoglobin, serum phosphorus, and LI were independently associated with CBF (P < 0.05). Mediation analysis demonstrated that CBF mediated the effects between hemoglobin and ID. Our study demonstrated that CBF mediated aberrant cerebral ID in hemodialysis patients with anemia.
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Affiliation(s)
- Huiying Wang
- The School of Medicine, Nankai
University, Tianjin, China
| | - Chao Chai
- Department of Radiology, Tianjin
First Central Hospital, School of Medicine, Nankai University, Tianjin,
China
- Imaging Medicine Institute of
Tianjin, Tianjin, China
| | - Gemuer Wu
- The School of Medicine, Nankai
University, Tianjin, China
| | - Jinping Li
- Department of Hemodialysis, Tianjin
First Central Hospital, School of Medicine, Nankai University, Tianjin,
China
| | - Chenxi Zhao
- Department of Radiology, First
Central Clinical College, Tianjin Medical University, Tianjin, China
| | - Dingwei Fu
- Department of Radiology, First
Central Clinical College, Tianjin Medical University, Tianjin, China
| | | | - Huapeng Wang
- Department of Radiology, First
Central Clinical College, Tianjin Medical University, Tianjin, China
| | - Beini Wang
- Department of Radiology, First
Central Clinical College, Tianjin Medical University, Tianjin, China
| | - Jinxia Zhu
- MR Collaboration, Siemens
Healthcare, Northeast Asia, Beijing, China
| | - Wen Shen
- Department of Radiology, Tianjin
First Central Hospital, School of Medicine, Nankai University, Tianjin,
China
- Imaging Medicine Institute of
Tianjin, Tianjin, China
| | - Shuang Xia
- Department of Radiology, Tianjin
First Central Hospital, School of Medicine, Nankai University, Tianjin,
China
- Imaging Medicine Institute of
Tianjin, Tianjin, China
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Northall A, Doehler J, Weber M, Vielhaber S, Schreiber S, Kuehn E. Layer-specific vulnerability is a mechanism of topographic map aging. Neurobiol Aging 2023; 128:17-32. [PMID: 37141729 DOI: 10.1016/j.neurobiolaging.2023.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 03/29/2023] [Accepted: 04/02/2023] [Indexed: 05/06/2023]
Abstract
Topographic maps form a critical feature of cortical organization, yet are poorly described with respect to their microstructure in the living aging brain. We acquired quantitative structural and functional 7T-MRI data from younger and older adults to characterize layer-wise topographic maps of the primary motor cortex (M1). Using parcellation-inspired techniques, we show that quantitative T1 and Quantitative Susceptibility Maps values of the hand, face, and foot areas differ significantly, revealing microstructurally distinct cortical fields in M1. We show that these fields are distinct in older adults and that myelin borders between them do not degenerate. We further show that the output layer 5 of M1 shows a particular vulnerability to age-related increased iron, while layer 5 and the superficial layer show increased diamagnetic substance, likely reflecting calcifications. Taken together, we provide a novel 3D model of M1 microstructure, where body parts form distinct structural units, but layers show specific vulnerability toward increased iron and calcium in older adults. Our findings have implications for understanding sensorimotor organization and aging, in addition to topographic disease spread.
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Affiliation(s)
- Alicia Northall
- Institute for Cognitive Neurology and Dementia Research (IKND), Otto-von-Guericke University Magdeburg, Saxony-Anhalt, Germany.
| | - Juliane Doehler
- Institute for Cognitive Neurology and Dementia Research (IKND), Otto-von-Guericke University Magdeburg, Saxony-Anhalt, Germany
| | - Miriam Weber
- Department of Neurology, Otto-von-Guericke University Magdeburg, Magdeburg, Saxony-Anhalt, Germany
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke University Magdeburg, Magdeburg, Saxony-Anhalt, Germany
| | - Stefanie Schreiber
- Department of Neurology, Otto-von-Guericke University Magdeburg, Magdeburg, Saxony-Anhalt, Germany; German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Saxony-Anhalt, Germany; Center for Behavioral Brain Sciences (CBBS) Magdeburg, Magdeburg, Saxony-Anhalt, Germany
| | - Esther Kuehn
- Institute for Cognitive Neurology and Dementia Research (IKND), Otto-von-Guericke University Magdeburg, Saxony-Anhalt, Germany; German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Saxony-Anhalt, Germany; Center for Behavioral Brain Sciences (CBBS) Magdeburg, Magdeburg, Saxony-Anhalt, Germany; Hertie Institute for Clinical Brain Research, Tübingen, Germany
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7
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Wang H, Song L, Li M, Yang Z, Wang ZC. Association between susceptibility value and cerebral blood flow in the bilateral putamen in patients undergoing hemodialysis. J Cereb Blood Flow Metab 2023; 43:433-445. [PMID: 36284493 PMCID: PMC9941863 DOI: 10.1177/0271678x221134384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hemodialysis (HD) is the most regularly applied replacement therapy for end-stage renal disease, but it may result in brain injuries. The correlation between cerebral blood flow (CBF) alteration and iron deposition has not been investigated in patients undergoing HD. Ferritin level may be a dominant factor in CBF and iron deposition change. We hypothesize that ferritin level might be the key mediator between iron deposition and CBF alteration. The correlation in the putamen was estimated between the susceptibility values and CBF in patients undergoing HD. Compared with healthy controls, patients showed more altered global susceptibility values and CBF. The susceptibility value was negatively correlated with CBF in the putamen in patients. Moreover, the susceptibility value was negatively correlated with ferritin level and positively correlated with serum iron level in the putamen of patients. CBF was positively correlated with ferritin level and negatively correlated with serum iron level in the putamen of patients. These findings indicate that iron dyshomeostasis and vascular damage might exist in the putamen in patients. The results revealed that iron dyshomeostasis and vascular damage in the putamen may be potential neural mechanisms for neurodegenerative processes in patients undergoing HD.
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Affiliation(s)
- Hao Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lijun Song
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Mingan Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhen-Chang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Zhang Y, Huang P, Wang X, Xu Q, Liu Y, Jin Z, Li Y, Cheng Z, Tang R, Chen S, He N, Yan F, Haacke EM. Visualizing the deep cerebellar nuclei using quantitative susceptibility mapping: An application in healthy controls, Parkinson's disease patients and essential tremor patients. Hum Brain Mapp 2023; 44:1810-1824. [PMID: 36502376 PMCID: PMC9921226 DOI: 10.1002/hbm.26178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 10/20/2022] [Accepted: 11/27/2022] [Indexed: 12/14/2022] Open
Abstract
The visualization and identification of the deep cerebellar nuclei (DCN) (dentate [DN], interposed [IN] and fastigial nuclei [FN]) are particularly challenging. We aimed to visualize the DCN using quantitative susceptibility mapping (QSM), predict the contrast differences between QSM and T2* weighted imaging, and compare the DCN volume and susceptibility in movement disorder populations and healthy controls (HCs). Seventy-one Parkinson's disease (PD) patients, 39 essential tremor patients, and 80 HCs were enrolled. The PD patients were subdivided into tremor dominant (TD) and postural instability/gait difficulty (PIGD) groups. A 3D strategically acquired gradient echo MR imaging protocol was used for each subject to obtain the QSM data. Regions of interest were drawn manually on the QSM data to calculate the volume and susceptibility. Correlation analysis between the susceptibility and either age or volume was performed and the intergroup differences of the volume and magnetic susceptibility in all the DCN structures were evaluated. For the most part, all the DCN structures were clearly visualized on the QSM data. The susceptibility increased as a function of volume for both the HC group and disease groups in the DN and IN (p < .001) but not the FN (p = .74). Only the volume of the FN in the TD-PD group was higher than that in the HCs (p = .012), otherwise, the volume and susceptibility among these four groups did not differ significantly. In conclusion, QSM provides clear visualization of the DCN structures. The results for the volume and susceptibility of the DCN can be used as baseline references in future studies of movement disorders.
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Affiliation(s)
- Youmin Zhang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pei Huang
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinhui Wang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiuyun Xu
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA
| | - Yu Liu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhijia Jin
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Li
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zenghui Cheng
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rongbiao Tang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shengdi Chen
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Naying He
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - E Mark Haacke
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA.,Department of Radiology, Wayne State University, Detroit, Michigan, USA
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Spence H, McNeil CJ, Waiter GD. Cognition and brain iron deposition in whole grey matter regions and hippocampal subfields. Eur J Neurosci 2022; 56:6039-6054. [PMID: 36215153 PMCID: PMC10092357 DOI: 10.1111/ejn.15838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/26/2022] [Accepted: 10/03/2022] [Indexed: 12/29/2022]
Abstract
Regional brain iron accumulation is observed in many neurodegenerative diseases, including Alzheimer's disease and Parkinson's disease, and is associated with cognitive decline. We explored associations between age, cognition and iron content in grey matter regions and hippocampal subfields in 380 participants of the Aberdeen children of the 1950s cohort and their first-generation relatives (aged 26-72 years). Participants underwent cognitive assessment at the time of MRI scanning. Quantitative susceptibility mapping of these MRI data was used to assess iron content in grey matter regions and in hippocampal subfields. Principle component analysis was performed on cognitive test scores to create a general cognition score. Spline analysis was used with the Akaike information criterion to determine if order 1, 2 or 3 natural splines were optimal for assessing non-linear relationships between regional iron and age. Multivariate linear models were used to assess associations between regional iron and cognition. Higher iron correlated with older age in the left putamen across all ages and in the right putamen of only participants over 58. Whereas a decrease in iron with older age was observed in the right thalamus and left pallidum across all ages. Right amygdala iron levels were associated with poorer general cognition scores and poorer immediate recall scores. Iron was not associated with any measures of cognitive performance in other regions of interest. Our results suggest that, whilst iron in some regions was associated with cognitive performance, there is an overall lack of association between regional iron content and cognitive ability in cognitively healthy individuals.
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Affiliation(s)
- Holly Spence
- Aberdeen Biomedical Imaging Centre, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Chris J McNeil
- Aberdeen Biomedical Imaging Centre, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Gordon D Waiter
- Aberdeen Biomedical Imaging Centre, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
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Howard CM, Jain S, Cook AD, Packard LE, Mullin HA, Chen N, Liu C, Song AW, Madden DJ. Cortical iron mediates age-related decline in fluid cognition. Hum Brain Mapp 2022; 43:1047-1060. [PMID: 34854172 PMCID: PMC8764476 DOI: 10.1002/hbm.25706] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 01/19/2023] Open
Abstract
Brain iron dyshomeostasis disrupts various critical cellular functions, and age-related iron accumulation may contribute to deficient neurotransmission and cell death. While recent studies have linked excessive brain iron to cognitive function in the context of neurodegenerative disease, little is known regarding the role of brain iron accumulation in cognitive aging in healthy adults. Further, previous studies have focused primarily on deep gray matter regions, where the level of iron deposition is highest. However, recent evidence suggests that cortical iron may also contribute to cognitive deficit and neurodegenerative disease. Here, we used quantitative susceptibility mapping (QSM) to measure brain iron in 67 healthy participants 18-78 years of age. Speed-dependent (fluid) cognition was assessed from a battery of 12 psychometric and computer-based tests. From voxelwise QSM analyses, we found that QSM susceptibility values were negatively associated with fluid cognition in the right inferior temporal gyrus, bilateral putamen, posterior cingulate gyrus, motor, and premotor cortices. Mediation analysis indicated that susceptibility in the right inferior temporal gyrus was a significant mediator of the relation between age and fluid cognition, and similar effects were evident for the left inferior temporal gyrus at a lower statistical threshold. Additionally, age and right inferior temporal gyrus susceptibility interacted to predict fluid cognition, such that brain iron was negatively associated with a cognitive decline for adults over 45 years of age. These findings suggest that iron may have a mediating role in cognitive decline and may be an early biomarker of neurodegenerative disease.
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Affiliation(s)
- Cortney M. Howard
- Center for Cognitive NeuroscienceDuke UniversityDurhamNorth CarolinaUSA
- Brain Imaging and Analysis CenterDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Shivangi Jain
- Brain Imaging and Analysis CenterDuke University Medical CenterDurhamNorth CarolinaUSA
- Present address:
Department of Psychological and Brain SciencesUniversity of IowaIowa CityIowaUSA
| | - Angela D. Cook
- Brain Imaging and Analysis CenterDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Lauren E. Packard
- Brain Imaging and Analysis CenterDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Hollie A. Mullin
- Brain Imaging and Analysis CenterDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Nan‐kuei Chen
- Brain Imaging and Analysis CenterDuke University Medical CenterDurhamNorth CarolinaUSA
- Present address:
Department of Biomedical EngineeringUniversity of ArizonaTucsonArizonaUSA
| | - Chunlei Liu
- Brain Imaging and Analysis CenterDuke University Medical CenterDurhamNorth CarolinaUSA
- Present address:
Department of Electrical Engineering and Computer SciencesUniversity of CaliforniaBerkeleyCaliforniaUSA
| | - Allen W. Song
- Brain Imaging and Analysis CenterDuke University Medical CenterDurhamNorth CarolinaUSA
| | - David J. Madden
- Center for Cognitive NeuroscienceDuke UniversityDurhamNorth CarolinaUSA
- Brain Imaging and Analysis CenterDuke University Medical CenterDurhamNorth CarolinaUSA
- Department of Psychiatry and Behavioral SciencesDuke University Medical CenterDurhamNorth CarolinaUSA
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11
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Chai C, Qiao P, Zhao B, Wang H, Liu G, Wu H, Shen W, Cao C, Ye X, Liu Z, Xia S. Brain gray matter nuclei segmentation on quantitative susceptibility mapping using dual-branch convolutional neural network? Artif Intell Med 2022; 125:102255. [DOI: 10.1016/j.artmed.2022.102255] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 12/27/2021] [Accepted: 02/05/2022] [Indexed: 12/12/2022]
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MacDonald ME, Pike GB. MRI of healthy brain aging: A review. NMR IN BIOMEDICINE 2021; 34:e4564. [PMID: 34096114 DOI: 10.1002/nbm.4564] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/08/2021] [Accepted: 05/11/2021] [Indexed: 06/12/2023]
Abstract
We present a review of the characterization of healthy brain aging using MRI with an emphasis on morphology, lesions, and quantitative MR parameters. A scope review found 6612 articles encompassing the keywords "Brain Aging" and "Magnetic Resonance"; papers involving functional MRI or not involving imaging of healthy human brain aging were discarded, leaving 2246 articles. We first consider some of the biogerontological mechanisms of aging, and the consequences of aging in terms of cognition and onset of disease. Morphological changes with aging are reviewed for the whole brain, cerebral cortex, white matter, subcortical gray matter, and other individual structures. In general, volume and cortical thickness decline with age, beginning in mid-life. Prevalent silent lesions such as white matter hyperintensities, microbleeds, and lacunar infarcts are also observed with increasing frequency. The literature regarding quantitative MR parameter changes includes T1 , T2 , T2 *, magnetic susceptibility, spectroscopy, magnetization transfer, diffusion, and blood flow. We summarize the findings on how each of these parameters varies with aging. Finally, we examine how the aforementioned techniques have been used for age prediction. While relatively large in scope, we present a comprehensive review that should provide the reader with sound understanding of what MRI has been able to tell us about how the healthy brain ages.
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Affiliation(s)
- M Ethan MacDonald
- Department of Electrical and Software Engineering, University of Calgary, Calgary, Alberta, Canada
- Departments of Radiology and Clinical Neuroscience, University of Calgary, Calgary, Alberta, Canada
- Healthy Brain Aging Laboratory, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - G Bruce Pike
- Departments of Radiology and Clinical Neuroscience, University of Calgary, Calgary, Alberta, Canada
- Healthy Brain Aging Laboratory, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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13
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Biel D, Steiger TK, Bunzeck N. Age-related iron accumulation and demyelination in the basal ganglia are closely related to verbal memory and executive functioning. Sci Rep 2021; 11:9438. [PMID: 33941809 PMCID: PMC8093241 DOI: 10.1038/s41598-021-88840-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 04/13/2021] [Indexed: 02/02/2023] Open
Abstract
Age-related cognitive decline has been linked to alterations of the dopaminergic system and its subcortical trajectories. Recent work suggests a critical role of iron accumulation within the basal ganglia (BG) in verbal memory performance, and increased iron levels have been related to demyelination. However, the specificity of age-related iron increases with respect to cognitive functions remains unclear. Therefore, we investigated the interplay of age, cognitive performance, and structural integrity of the BG. In total, 79 healthy older participants underwent a broad cognitive assessment (fluid and crystallized intelligence, verbal and numeric memory, processing speed, executive functions) and structural MRI. As expected, performance in most cognitive tests had a negative relationship with age. Moreover, BG grey matter volume and magnetization transfer (MT, indicative of myelin) decreased, and R2* (indicative of iron) increased with age. Importantly, R2* and demyelination negatively correlated with verbal memory and executive functions. Within the SN/VTA, age correlated negatively with MT, but there was no clear evidence in favor of a relationship between behavior and R2* or MT. Our results suggest that age-related increases in iron and demyelination within the BG, which are part of a fronto-striatal network, not only impact on verbal memory but also executive functions.
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Affiliation(s)
- Davina Biel
- grid.4562.50000 0001 0057 2672Department of Psychology, University of Lübeck, 23562 Lübeck, Germany ,grid.5252.00000 0004 1936 973XInstitute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, 81377 Munich, Germany
| | - Tineke K. Steiger
- grid.4562.50000 0001 0057 2672Department of Psychology, University of Lübeck, 23562 Lübeck, Germany
| | - Nico Bunzeck
- grid.4562.50000 0001 0057 2672Department of Psychology, University of Lübeck, 23562 Lübeck, Germany ,grid.4562.50000 0001 0057 2672Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
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Spence H, McNeil CJ, Waiter GD. The impact of brain iron accumulation on cognition: A systematic review. PLoS One 2020; 15:e0240697. [PMID: 33057378 PMCID: PMC7561208 DOI: 10.1371/journal.pone.0240697] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/01/2020] [Indexed: 12/31/2022] Open
Abstract
Iron is involved in many processes in the brain including, myelin generation, mitochondrial function, synthesis of ATP and DNA and the cycling of neurotransmitters. Disruption of normal iron homeostasis can result in iron accumulation in the brain, which in turn can partake in interactions which amplify oxidative damage. The development of MRI techniques for quantifying brain iron has allowed for the characterisation of the impact that brain iron has on cognition and neurodegeneration. This review uses a systematic approach to collate and evaluate the current literature which explores the relationship between brain iron and cognition. The following databases were searched in keeping with a predetermined inclusion criterion: Embase Ovid, PubMed and PsychInfo (from inception to 31st March 2020). The included studies were assessed for study characteristics and quality and their results were extracted and summarised. This review identified 41 human studies of varying design, which statistically assessed the relationship between brain iron and cognition. The most consistently reported interactions were in the Caudate nuclei, where increasing iron correlated poorer memory and general cognitive performance in adulthood. There were also consistent reports of a correlation between increased Hippocampal and Thalamic iron and poorer memory performance, as well as, between iron in the Putamen and Globus Pallidus and general cognition. We conclude that there is consistent evidence that brain iron is detrimental to cognitive health, however, more longitudinal studies will be required to fully understand this relationship and to determine whether iron occurs as a primary cause or secondary effect of cognitive decline.
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Affiliation(s)
- Holly Spence
- Aberdeen Biomedical Imaging Centre, Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
- * E-mail:
| | - Chris J. McNeil
- Aberdeen Biomedical Imaging Centre, Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Gordon D. Waiter
- Aberdeen Biomedical Imaging Centre, Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
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15
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Milovic C, Tejos C, Acosta-Cabronero J, Özbay PS, Schwesser F, Marques JP, Irarrazaval P, Bilgic B, Langkammer C. The 2016 QSM Challenge: Lessons learned and considerations for a future challenge design. Magn Reson Med 2020; 84:1624-1637. [PMID: 32086836 PMCID: PMC7526054 DOI: 10.1002/mrm.28185] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/09/2019] [Accepted: 01/06/2020] [Indexed: 11/06/2022]
Abstract
PURPOSE The 4th International Workshop on MRI Phase Contrast and QSM (2016, Graz, Austria) hosted the first QSM Challenge. A single-orientation gradient recalled echo acquisition was provided, along with COSMOS and the χ33 STI component as ground truths. The submitted solutions differed more than expected depending on the error metric used for optimization and were generally over-regularized. This raised (unanswered) questions about the ground truths and the metrics utilized. METHODS We investigated the influence of background field remnants by applying additional filters. We also estimated the anisotropic contributions from the STI tensor to the apparent susceptibility to amend the χ33 ground truth and to investigate the impact on the reconstructions. Lastly, we used forward simulations from the COSMOS reconstruction to investigate the impact noise had on the metric scores. RESULTS Reconstructions compared against the amended STI ground truth returned lower errors. We show that the background field remnants had a minor impact in the errors. In the absence of inconsistencies, all metrics converged to the same regularization weights, whereas structural similarity index metric was more insensitive to such inconsistencies. CONCLUSION There was a mismatch between the provided data and the ground truths due to the presence of unaccounted anisotropic susceptibility contributions and noise. Given the lack of reliable ground truths when using in vivo acquisitions, simulations are suggested for future QSM Challenges.
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Affiliation(s)
- Carlos Milovic
- Department of Electrical Engineering, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Biomedical Imaging Center, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, Chile
| | - Cristian Tejos
- Department of Electrical Engineering, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Biomedical Imaging Center, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, Chile
| | | | - Pinar Senay Özbay
- Laboratory of Functional and Molecular Imaging, National Institutes of Health, Bethesda, MD, USA
| | - Ferdinand Schwesser
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, The State University of New York, NY, USA
- Center for Biomedical Imaging, Clinical and Translational Science Institute, University at Buffalo, The State University of New York, NY, USA
| | - Jose Pedro Marques
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Pablo Irarrazaval
- Department of Electrical Engineering, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, Chile
- Institute for Biological and Medical Engineering, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Berkin Bilgic
- Martinos Center for Biomedical Imaging, Harvard Medical School, MA, USA
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16
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Cheng Q, Huang J, Liang J, Ma M, Zhao Q, Lei X, Shi C, Luo L. Evaluation of abnormal iron distribution in specific regions in the brains of patients with Parkinson's disease using quantitative susceptibility mapping and R2 * mapping. Exp Ther Med 2020; 19:3778-3786. [PMID: 32346442 PMCID: PMC7185157 DOI: 10.3892/etm.2020.8645] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 02/28/2020] [Indexed: 02/07/2023] Open
Abstract
The primary aim of the present study was to evaluate abnormal iron distribution in specific regions of the brains in patients with Parkinson's disease (PD) using quantitative susceptibility mapping (QSM) and R2* mapping, and to compare the diagnostic performances of QSM and R2* mapping in differentiating patients with PD with that in normal controls. A total of 25 patients with idiopathic PD and 28 sex-and age-matched normal controls were included in the present study and their brains investigated using a 3T scanner. Magnetic resonance imaging techniques, namely, QSM and R2* mapping, were applied to generate susceptibility and R2* values. The differences in susceptibility and R2* values in deep grey matter nuclei between patients with PD and the normal controls were compared using independent samples t-tests. The abilities of QSM and R2* mapping to classify patients with PD and normal controls were analyzed using receiver operating characteristic curves. Correlation analyses between imaging parameters (e.g. susceptibility and R2* values) and clinical feature (disease severity assessed using the Hoehn and Yahr score) were performed. The intra-class correlation coefficient (ICC) for susceptibility (ICC=0.977; P<0.001) and R2* (ICC=0.945; P<0.001) values between two neuro-radiologists were >0.81, showing excellent inter-rater agreement. The susceptibility values were significantly increased in the substantia nigra (SN) and red nucleus, but were decreased in the putamen of patients with PD compared with that in the corresponding brain regions of normal controls. However, increased R2* values were observed only in the SN in patients with PD. QSM showed higher sensitivity and specificity compared with R2* mapping to separate the patients with PD from the normal controls. There were no significant correlations between the susceptibility/R2* values and clinical features in all targeted regions of the brains in patients with PD. In conclusion, both QSM and R2* mapping are feasible to calculate the iron levels in human brains, and QSM provides a more sensitive and accurate method to assess regional abnormal iron distribution in patients with PD.
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Affiliation(s)
- Qingqing Cheng
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, P.R. China
| | - Jiaxi Huang
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, P.R. China
| | - Jianye Liang
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, P.R. China
| | - Mengjie Ma
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, P.R. China
| | - Qian Zhao
- School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong 511436, P.R. China
| | - Xueping Lei
- Key Laboratory of Molecular Target and Clinical Pharmacology, School of Pharmaceutical Sciences and Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510799, P.R. China
| | - Changzheng Shi
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, P.R. China
| | - Liangping Luo
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, P.R. China
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17
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Young PNE, Estarellas M, Coomans E, Srikrishna M, Beaumont H, Maass A, Venkataraman AV, Lissaman R, Jiménez D, Betts MJ, McGlinchey E, Berron D, O'Connor A, Fox NC, Pereira JB, Jagust W, Carter SF, Paterson RW, Schöll M. Imaging biomarkers in neurodegeneration: current and future practices. Alzheimers Res Ther 2020; 12:49. [PMID: 32340618 PMCID: PMC7187531 DOI: 10.1186/s13195-020-00612-7] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 04/01/2020] [Indexed: 12/12/2022]
Abstract
There is an increasing role for biological markers (biomarkers) in the understanding and diagnosis of neurodegenerative disorders. The application of imaging biomarkers specifically for the in vivo investigation of neurodegenerative disorders has increased substantially over the past decades and continues to provide further benefits both to the diagnosis and understanding of these diseases. This review forms part of a series of articles which stem from the University College London/University of Gothenburg course "Biomarkers in neurodegenerative diseases". In this review, we focus on neuroimaging, specifically positron emission tomography (PET) and magnetic resonance imaging (MRI), giving an overview of the current established practices clinically and in research as well as new techniques being developed. We will also discuss the use of machine learning (ML) techniques within these fields to provide additional insights to early diagnosis and multimodal analysis.
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Affiliation(s)
- Peter N E Young
- Wallenberg Centre for Molecular and Translational Medicine and the Department of Psychiatry and Neurochemistry, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mar Estarellas
- Centre for Medical Image Computing (CMIC), Department of Computer Science & Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Emma Coomans
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Meera Srikrishna
- Wallenberg Centre for Molecular and Translational Medicine and the Department of Psychiatry and Neurochemistry, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helen Beaumont
- Neuroscience and Aphasia Research Unit, Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, UK
| | - Anne Maass
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Ashwin V Venkataraman
- Division of Brain Sciences, Imperial College London, London, UK
- United Kingdom Dementia Research Institute, Imperial College London, London, UK
| | - Rikki Lissaman
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff, UK
| | - Daniel Jiménez
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
- Department of Neurological Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Matthew J Betts
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | | | - David Berron
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Antoinette O'Connor
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Nick C Fox
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Joana B Pereira
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - William Jagust
- Helen Wills Neuroscience Institute, University of California, Berkeley, USA
- Molecular Biophysics and Integrated Bioimaging, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Stephen F Carter
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Wolfson Molecular Imaging Centre, Division of Neuroscience and Experimental Psychology, MAHSC, University of Manchester, Manchester, UK
| | - Ross W Paterson
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Michael Schöll
- Wallenberg Centre for Molecular and Translational Medicine and the Department of Psychiatry and Neurochemistry, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK.
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
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18
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Xie F, Weihua L, Lirong O, Wang X, Xing W. Quantitative susceptibility mapping in spinocerebellar ataxia type 3/Machado-Joseph disease (SCA3/MJD). Acta Radiol 2020; 61:520-527. [PMID: 31450947 DOI: 10.1177/0284185119868906] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background The deep nuclei, brainstem, and anterior central gyrus are important sites of spinocerebellar ataxia type3/Machado–Joseph Disease (SCA3/MJD) involvement. These locations were the common iron deposition areas. We hypothesized that iron deposition changes occur in SCA3/MJD patients and are associated with disease progression. Purpose Quantitative susceptibility mapping was used to quantitatively analyze changes in iron levels in SCA3/MJD patients. Material and Methods Eighteen symptomatic SCA3/MJD patients and 18 age-matched normal controls (group 1; NC1), and 12 asymptomatic mutation carriers (pre-SCA3/MJD) and 16 age-matched normal controls (group 2; NC2) were examined by enhanced gradient echo T2*-weighted angiography. Data were processed to obtain the quantitative susceptibility mapping values. Independent sample t-tests were conducted to compare the differences in the quantitative susceptibility mapping values. Results In the red nuclei and substantia nigra, the quantitative susceptibility mapping values of the symptomatic SCA3/MJD group were significantly higher than those of NC1 ( P < 0.05). The quantitative susceptibility mapping values of the symptomatic SCA3/MJD group were higher than those of NC1 in the globus pallidus, but it was not statistically significant ( P = 0.056). No significant difference in quantitative susceptibility mapping values was found between the pre-SCA3/MJD and NC2. No significant correlation was found between the International Cooperative Ataxia Rating Scale and the Scale for the Assessment and Rating of Ataxia and the quantitative susceptibility mapping values. Conclusion The results clearly demonstrated the quantitative susceptibility mapping value increase in the globus pallidus, red nuclei, and substantia nigra of the symptomatic SCA3/MJD group, indicating iron overload in these nuclei, suggesting that iron deposition is associated with disease onset.
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Affiliation(s)
- Fangfang Xie
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, PR China
| | - Liao Weihua
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, PR China
| | - Ouyang Lirong
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, PR China
| | - Xiaoyi Wang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, PR China
| | - Wu Xing
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, PR China
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19
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Wang H, Han X, Jin M, Wang LY, Diao ZL, Guo W, Zhang P, Wang Z, Ding HY, Lv H, Zhang ZY, Zhao PF, Li J, Yang ZH, Liu WH, Wang ZC. Different iron deposition patterns in hemodialysis patients with and without restless legs syndrome: a quantitative susceptibility mapping study. Sleep Med 2020; 69:34-40. [PMID: 32045852 DOI: 10.1016/j.sleep.2019.12.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/13/2019] [Accepted: 12/29/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Brain iron deposition in hemodialysis (HD) patients increases over time. Iron deficiency in gray matter nuclei has been reported to lead to idiopathic restless legs syndrome (RLS) symptoms. Regardless of unpleasant RLS sensations, the patterns of iron deposition between hemodialysis patients with RLS (HD-RLS) and hemodialysis patients without RLS (HD-nRLS) are still unclear. To evaluate the differences in iron deposition patterns between HD-RLS and HD-nRLS patients, we utilized quantitative susceptibility mapping (QSM). METHODS In sum, 24 HD-RLS patients, 25 HD-nRLS patients and 30 age- and sex-matched healthy controls (HCs) were enrolled. The QSM was used to assess susceptibility values of the regions of interest (ROIs), including the caudate nucleus (CN), putamen (PUT), globus pallidus (GP), thalamus (THA), substantia nigra (SN), red nucleus (RN) and dentate nucleus (DN). RESULTS HD duration was significantly longer in HD-RLS patients than in HD-nRLS patients (P < 0.05). The susceptibility of HD-RLS and HD-nRLS patients in PUT was higher than that in HCs (P < 0.05), illustrating elevated iron content in the nucleus. Compared with HD-nRLS patients, HD-RLS patients demonstrated reduced susceptibility in CN and PUT (both P < 0.05). Compared with HCs, HD-RLS patients displayed decreased susceptibility in DN (P < 0.05). CONCLUSIONS Different iron deposition patterns between HD-RLS and HD-nRLS patients in PUT and DN, which further support disturbed sensory processing in RLS, may be involved in RLS pathogenesis in HD patients.
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Affiliation(s)
- Hao Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xue Han
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Mei Jin
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Li-Yan Wang
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zong-Li Diao
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wang Guo
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Peng Zhang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zheng Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - He-Yu Ding
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Han Lv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zheng-Yu Zhang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Peng-Fei Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jing Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zheng-Han Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wen-Hu Liu
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Zhen-Chang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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20
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Shen X, Yang H, Zhang D, Jiang H. Iron Concentration Does Not Differ in Blood but Tends to Decrease in Cerebrospinal Fluid in Parkinson's Disease. Front Neurosci 2019; 13:939. [PMID: 31616238 PMCID: PMC6775209 DOI: 10.3389/fnins.2019.00939] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/21/2019] [Indexed: 12/14/2022] Open
Abstract
Background Iron accumulation in the substantia nigra in PD patients was acknowledged, but the studies on alteration of iron levels in blood and cerebrospinal fluids (CSF) reported inconsistent results. Objective To determinate the alterations of blood and CSF levels of iron in PD patients, a case-control study and a meta-analysis both in blood and CSF were conducted. Methods In the case-control study, 43 PD patients and 33 controls were recruited to test iron metabolism, 15 normal and 12 PD patients donated CSF. Levels in iron were quantified by inductively coupled atomic emission spectrometry. Iron metabolism was analyzed by routine blood tests. In the meta-analysis, a comprehensive literature search was performed on relevant studies published from Jan 1980 to Dec 2018 in PubMed, Web of Science and EMBASE databases. The pooled standard mean difference (SMD) with random effects model was selected to estimate the association between iron levels and PD. Results In the case-control study, the iron level in serum in the controls and PD patients were 110.00 ± 48.75 μg/dl and 107.21 ± 34.25 μg/dl, respectively, no significant difference was found between them (p = 0.850), with a small effect size (Cohen’s d: 0.12; 95% CI: 0.08–0.17). Ferritin level in PD patients was lower than controls (p = 0.014). The CSF levels of iron in control and the PD patients were 20.14 ± 3.35 ng/dl and 16.26 ± 4.82 ng/dl, respectively. CSF levels of iron were lower in PD compared with that of controls (p = 0.021), with a moderate effect size (Cohen’s d: 0.51; 95% CI: 0.43–0.65). In the meta-analysis, 22 eligible studies and a total of 3607 participants were identified. Blood levels of iron did not differ significant between PD patients and the controls [SMD (95% CI): −0.03 (−0.30, 0.24)], but CSF iron levels tended to be lower in PD patients compared with that in the controls [SMD (95% CI): −0.33 (−0.65, −0.00)]. Conclusion Iron homeostasis may be disturbed in CSF, but not in the peripheral blood in PD.
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Affiliation(s)
- Xiaoli Shen
- Department of Physiology, Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders and State Key Disciplines: Physiology, Qingdao University, Qingdao, China.,Department of Epidemiology and Health Statistics, Qingdao University, Qingdao, China
| | - Huazhen Yang
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, China
| | - Dongfeng Zhang
- Department of Epidemiology and Health Statistics, Qingdao University, Qingdao, China
| | - Hong Jiang
- Department of Physiology, Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders and State Key Disciplines: Physiology, Qingdao University, Qingdao, China
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21
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Chen L, Hua J, Ross CA, Cai S, van Zijl PC, Li X. Altered brain iron content and deposition rate in Huntington's disease as indicated by quantitative susceptibility MRI. J Neurosci Res 2019; 97:467-479. [PMID: 30489648 PMCID: PMC6367012 DOI: 10.1002/jnr.24358] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/08/2018] [Accepted: 11/08/2018] [Indexed: 12/14/2022]
Abstract
Altered brain iron content in the striatum of premanifest and manifest Huntington's disease (HD) has been reported. However, its natural history remains unclear. This study aims to investigate altered brain iron content in premanifest and early HD, and the iron deposition rate in these patients through a longitudinal one-year follow-up test, with quantitative magnetic susceptibility as an iron imaging marker. Twenty-four gene mutation carriers divided into three groups (further-from-onset, closer-to-onset and early HD) and 16 age-matched healthy controls were recruited at baseline, and of these, 14 carriers and 7 controls completed the one-year follow-up. Quantitative magnetic susceptibility and effective transverse relaxation rate ( R 2 ∗ ) were measured at 7.0 Tesla and correlated with atrophy and available clinical and cognitive measurements. Higher susceptibility values indicating higher iron content in the striatum and globus pallidus were only observed in closer-to-onset (N = 6, p < 0.05 in caudate and p < 0.01 in putamen) and early HD (N = 9, p < 0.05 in caudate and globus pallidus and p < 0.01 in putamen). Similar results were found by R 2 ∗ measurement. Such increases directly correlated with HD CAG-age product score and brain atrophy, but not with motor or cognitive scores. More importantly, a significantly higher iron deposition rate (11.9%/years in caudate and 6.1%/years in globus pallidus) was firstly observed in closer-to-onset premanifest HD and early HD as compared to the controls. These results suggest that monitoring brain iron may provide further insights into the pathophysiology of HD disease progression, and may provide a biomarker for clinical trials.
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Affiliation(s)
- Lin Chen
- Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Xiamen University, Xiamen, China
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, United States
- Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, United States
| | - Jun Hua
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, United States
- Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, United States
| | - Christopher A. Ross
- Department of Psychiatry, Division of Neurobiology, and Departments of Neurology, Neuroscience and Pharmacology, Johns Hopkins University, Baltimore, Maryland, United States
| | - Shuhui Cai
- Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Xiamen University, Xiamen, China
| | - Peter C.M. van Zijl
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, United States
- Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, United States
| | - Xu Li
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, United States
- Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, United States
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22
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Functional coherence of striatal resting-state networks is modulated by striatal iron content. Neuroimage 2018; 183:495-503. [DOI: 10.1016/j.neuroimage.2018.08.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 01/03/2023] Open
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23
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Si QQ, Yuan YS, Zhi Y, Tong Q, Zhang L, Zhang K. Plasma transferrin level correlates with the tremor-dominant phenotype of Parkinson’s disease. Neurosci Lett 2018; 684:42-46. [DOI: 10.1016/j.neulet.2018.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/12/2018] [Accepted: 07/03/2018] [Indexed: 01/19/2023]
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24
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Du L, Zhao Z, Cui A, Zhu Y, Zhang L, Liu J, Shi S, Fu C, Han X, Gao W, Song T, Xie L, Wang L, Sun S, Guo R, Ma G. Increased Iron Deposition on Brain Quantitative Susceptibility Mapping Correlates with Decreased Cognitive Function in Alzheimer's Disease. ACS Chem Neurosci 2018; 9:1849-1857. [PMID: 29722955 DOI: 10.1021/acschemneuro.8b00194] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The excessive accumulation of iron in deep gray structures is an important pathological characteristic in patients with Alzheimer's disease (AD). Quantitative susceptibility mapping (QSM) is more specific than other imaging-based iron measurement modalities and allows noninvasive assessment of tissue magnetic susceptibility, which has been shown to correlate well with brain iron levels. This study aimed to investigate the correlations between the magnetic susceptibility values of deep gray matter nuclei and the cognitive functions assessed by mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) in patients with mild and moderate AD. Thirty subjects with mild and moderate AD and 30 age- and sex-matched healthy controls were scanned with a 3.0 T magnetic resonance imaging (MRI) scanner. The magnetic susceptibilities of the regions of interest (ROIs), including caudate nucleus (Cd), putamen (Pt), globus pallidus (Gp), thalamus (Th), red nucleus (Rn), substantia nigra (Sn), and dentate nucleus (Dn), were quantified by QSM. We found that the susceptibility values of the bilateral Cd and Pt were significantly higher in AD patients than the controls ( P < 0.05). In contrast, bilateral Rn had significantly lower susceptibility values in AD than the controls. Regardless of gender and age, the increase of magnetic susceptibility in the left Cd was significantly correlated with the decrease of MMSE scores and MoCA scores ( P < 0.05). Our study indicated that magnetic susceptibility value of left Cd could be potentially used as a biomarker of disease severity in mild and moderate AD.
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Affiliation(s)
- Lei Du
- Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Zifang Zhao
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Ailing Cui
- Anatomy Department, Changzhi Medical College, Changzhi, 046000 Shanxi China
| | - Yijiang Zhu
- Department of Imaging, ANHUI Provincial Hospital, Hefei, 230000 Anhui China
| | - Lu Zhang
- Department of Science and Education, Shangluo Central Hospital, Shangluo 726000, China
| | - Jing Liu
- Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Sumin Shi
- Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Chao Fu
- Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Xiaowei Han
- Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Wenwen Gao
- Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Tianbin Song
- Department of Nuclear Medicine, Xuanwu Hospital, Beijing 100053, China
| | - Lizhi Xie
- GE Healthcare, MR Research, Beijing 100176, China
| | - Lei Wang
- Department of Neurology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Shilong Sun
- Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Runcai Guo
- Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Guolin Ma
- Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, China
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25
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Wang X, Zhang R, Wei W, Jiang H, Gao Z, Lin J, Zhang J. Long-term sequelae of hippocampal lesions in patients with transient global amnesia: A multiparametric MRI study. J Magn Reson Imaging 2017; 47:1350-1358. [PMID: 28884957 DOI: 10.1002/jmri.25844] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/09/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND MRI signal diffusion-weighted imaging (DWI) hyperintensity in the hippocampus in patients with transient global amnesia (TGA) are resolved within several days after the onset of TGA. PURPOSE To use multiparametric MRI to unravel the sequelae of TGA. STUDY TYPE A prospective longitudinal study. POPULATION Eight TGA patients. FIELD STRENGTH/SEQUENCE A 3.0T Siemens Tim Trio MRI scanner with T1 -weighted MPRAGE, diffusion-weighted echo planar imaging, and multiecho gradient-recalled echo sequences. ASSESSMENT Brain MRI scanned within 72 hours, 2 weeks, and 3 months after onset of TGA, respectively. T1 image hippocampus was first segmented into 12 subregions using FreeSurfer and registered to DWI to locate DWI lesion. Then a T1 image with segmented hippocampus was registered to its corresponding apparent diffusion coefficient (ADC) map, fractional anisotropy (FA) map, and quantitative susceptibility map, respectively. Finally, the volume, water diffusion and anisotropy, and magnetic susceptibility of DWI lesion were analyzed. STATISTICAL TESTS A paired samples t-test was performed to detect measurement differences between three tests. Pearson correlation was used to assess the correlations between all measurements. RESULTS Hyperintensity was detected in the head, body, and caudate of CA1 and hippocampal tail. No significant changes existed in CA1/unit volume across the three timepoint measurements (all, P > 0.480). In Test 1, ratio ADC (DWI lesion / adjacent healthy, rADC) and ratio FA (rFA) decreased below, while ratio susceptibility increased above 1.0. In Test 2, all the episodes normalized around 1.0. In Test 3, rADC remained normalization, but rFA decreased and ratio susceptibility increased again. In Test 1 and Test 3 (vs. Test 2), decreased FA values were accompanied with lower axial diffusivity and/or higher radial diffusivity (all, P < 0.001). Moreover, rFA significantly correlated with ratio susceptibility in Test 3 (r = -0.665, P = 0.039). DATA CONCLUSION Microstructural sequelae in hippocampus were demonstrated, which indicates that ischemic lesions may be associated with TGA. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:1350-1358.
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Affiliation(s)
- Xiaochuan Wang
- Department of Neurology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, P.R. China
| | - Ran Zhang
- Institute of Brain Diseases and Cognition, Medical College of Xiamen University, Xiamen, P.R. China
| | - Wenping Wei
- MRI Center, First Affiliated Hospital of Xiamen University, Xiamen, P.R. China
| | - Haibo Jiang
- Department of Neurology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, P.R. China
| | - Zhongming Gao
- Department of Neurology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, P.R. China
| | - Jianzhong Lin
- Magnetic Resonance Center, Zhongshan Hospital Xiamen University, Xiamen, P.R. China
| | - Jiaxing Zhang
- Institute of Brain Diseases and Cognition, Medical College of Xiamen University, Xiamen, P.R. China
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26
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Yao S, Zhong Y, Xu Y, Qin J, Zhang N, Zhu X, Li Y. Quantitative Susceptibility Mapping Reveals an Association between Brain Iron Load and Depression Severity. Front Hum Neurosci 2017; 11:442. [PMID: 28900391 PMCID: PMC5581806 DOI: 10.3389/fnhum.2017.00442] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/17/2017] [Indexed: 01/13/2023] Open
Abstract
Previous studies have detected abnormal serum ferritin levels in patients with depression; however, the results have been inconsistent. This study used quantitative susceptibility mapping (QSM) for the first time to examine brain iron concentration in depressed patients and evaluated whether it is related to severity. We included three groups of age- and gender-matched participants: 30 patients with mild-moderate depression (MD), 14 patients with major depression disorder (MDD) and 20 control subjects. All participants underwent MR scans with a 3D gradient-echo sequence reconstructing for QSM and performed the 17-item Hamilton Depression Rating Scale (HDRS) test. In MDD, the susceptibility value in the bilateral putamen was significantly increased compared with MD or control subjects. In addition, a significant difference was also observed in the left thalamus in MDD patients compared with controls. However, the susceptibility values did not differ between MD patients and controls. The susceptibility values positively correlated with the severity of depression as indicated by the HDRS scores. Our results provide evidence that brain iron deposition may be associated with depression and may even be a biomarker for investigating the pathophysiological mechanism of depression.
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Affiliation(s)
- Shun Yao
- Department of Radiology, The Affiliated Hospital of Jiangsu UniversityZhenjiang, China
| | - Yi Zhong
- Department of Research and Development, Magnetic Resonance Innovations Inc.Detroit, MI, United States
| | - Yuhao Xu
- Department of Neurology, The Affiliated Hospital of Jiangsu UniversityZhenjiang, China
| | - Jiasheng Qin
- Department of Radiology, The Affiliated Hospital of Jiangsu UniversityZhenjiang, China
| | - Ningning Zhang
- Department of Radiology, The Affiliated Hospital of Jiangsu UniversityZhenjiang, China
| | - Xiaolan Zhu
- Department of Gynaecology and Obstetrics, The Fourth Affiliated Hospital of Jiangsu UniversityZhenjiang, China
| | - Yuefeng Li
- Department of Radiology, The Affiliated Hospital of Jiangsu UniversityZhenjiang, China
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27
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Guan X, Xuan M, Gu Q, Huang P, Liu C, Wang N, Xu X, Luo W, Zhang M. Regionally progressive accumulation of iron in Parkinson's disease as measured by quantitative susceptibility mapping. NMR IN BIOMEDICINE 2017; 30:10.1002/nbm.3489. [PMID: 26853890 PMCID: PMC4977211 DOI: 10.1002/nbm.3489] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 12/11/2015] [Accepted: 12/28/2015] [Indexed: 05/23/2023]
Abstract
The progression of Parkinson's disease (PD) seems to vary according to the disease stage, which greatly influences the management of PD patients. However, the underlying mechanism of progression in PD remains unclear. This study was designed to explore the progressive pattern of iron accumulation at different stages in PD patients. Sixty right-handed PD patients and 40 normal controls were recruited. According to the disease stage, 45 patients with Hoehn-Yahr stage ≤ 2.5 and 15 patients with Hoehn-Yahr stage ≥ 3 were grouped into early-stage PD (EPD) and late-stage PD (LPD) groups, respectively. The iron content in the cardinal subcortical nuclei covering the cerebrum, cerebellum and midbrain was measured using quantitative susceptibility mapping (QSM). The substantia nigra pars compacta (SNc) showed significantly increased QSM values in the EPD patients compared with the controls. In the LPD patients, while the SNc continued to show increased QSM values compared with the controls and EPD patients, the regions showing increased QSM values spread to include the substantia nigra pars reticulata (SNr), red nucleus (RN) and globus pallidus (GP). Our data also indicated that iron deposition was more significant in the GP internal segment (GPi) than in the GP external segment. No other regions showed significant changes in QSM values among the groups. Therefore, we were able to confirm a regionally progressive pattern of iron accumulation in the different stages of PD, indicating that iron deposition in the SNc is affected exclusively in the early stages of the disease, while the SNr, RN and GP, and particularly the GPi segment, become involved in advanced stages of the disease. This is a preliminary study providing objective evidence of the iron-related progression in PD. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Xiaojun Guan
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Min Xuan
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Quanquan Gu
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Peiyu Huang
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chunlei Liu
- Brain Imaging and Analysis Center, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Nian Wang
- Brain Imaging and Analysis Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Xiaojun Xu
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Luo
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Minming Zhang
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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28
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Sun Y, Ge X, Han X, Cao W, Wang Y, Ding W, Cao M, Zhang Y, Xu Q, Zhou Y, Xu J. Characterizing Brain Iron Deposition in Patients with Subcortical Vascular Mild Cognitive Impairment Using Quantitative Susceptibility Mapping: A Potential Biomarker. Front Aging Neurosci 2017; 9:81. [PMID: 28424610 PMCID: PMC5371674 DOI: 10.3389/fnagi.2017.00081] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 03/14/2017] [Indexed: 11/13/2022] Open
Abstract
The presence and pattern of iron accumulation in subcortical vascular mild cognitive impairment (svMCI) and their effects on cognition have rarely been investigated. We aimed to examine brain iron deposition in svMCI subjects using quantitative susceptibility mapping (QSM). Moreover, we aimed to investigate the correlation between brain iron deposition and the severity of cognitive impairment as indicated by z-scores. We recruited 20 subcortical ischemic vascular disease (SIVD) patients who fulfilled the criteria for svMCI. The control group comprised 19 SIVD patients without cognitive impairment. The SIVD and control groups were matched based on age, gender, and years of education. Both groups underwent QSM using a 3.0T MRI system. Susceptibility maps were reconstructed from in vivo data, which were acquired with a three-dimensional spoiled gradient recalled sequence. Then, regions of interest were drawn manually on the map of each subject. The inter-group differences of susceptibility values were explored in deep gray matter nuclei, including the bilateral pulvinar nucleus of the thalamus, head of caudate nucleus, globus pallidus, putamen, hippocampus, substantia nigra, and red nucleus. The correlations between regional iron deposition and composite z-score, memory z-score, language z-score, attention-executive z-score and visuospatial z-score were assessed using partial correlation analysis, with patient age and gender as covariates. Compared with the control, the svMCI group had elevated susceptibility values within the bilateral hippocampus and right putamen. Furthermore, the susceptibility value in the right hippocampus was negatively correlated with memory z-score and positively correlated with language z-score. The susceptibility value in the right putamen was negatively correlated with attention-executive z-score in the svMCI group. However, composite z-score were unrelated to susceptibility values. Our results suggest that brain iron deposition has clinical relevance as a biomarker for cognition. In addition, our results highlight the importance of iron deposition in understanding svMCI-associated cognitive deficits in addition to conventional MRI markers.
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Affiliation(s)
- Yawen Sun
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai, China
| | - Xin Ge
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai, China
| | - Xu Han
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai, China
| | - Wenwei Cao
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai, China
| | - Yao Wang
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai, China
| | - Weina Ding
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai, China
| | - Mengqiu Cao
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai, China
| | - Yong Zhang
- GE Applied Science Laboratory, GE HealthcareShanghai, China
| | - Qun Xu
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai, China
| | - Yan Zhou
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai, China
| | - Jianrong Xu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai, China
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29
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Hanspach J, Dwyer MG, Bergsland NP, Feng X, Hagemeier J, Bertolino N, Polak P, Reichenbach JR, Zivadinov R, Schweser F. Methods for the computation of templates from quantitative magnetic susceptibility maps (QSM): Toward improved atlas- and voxel-based analyses (VBA). J Magn Reson Imaging 2017; 46:1474-1484. [PMID: 28263417 DOI: 10.1002/jmri.25671] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 01/30/2017] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To develop and assess a method for the creation of templates for voxel-based analysis (VBA) and atlas-based approaches using quantitative magnetic susceptibility mapping (QSM). MATERIALS AND METHODS We studied four strategies for the creation of magnetic susceptibility brain templates, derived as successive extensions of the conventional template generation (CONV) based on only T1 -weighted (T1 w) images. One method that used only T1 w images involved a minor improvement of CONV (U-CONV). One method used only magnetic susceptibility maps as input for template generation (DIRECT), and the other two used a linear combination of susceptibility and T1 w images (HYBRID) and an algorithm that directly used both image modalities (MULTI), respectively. The strategies were evaluated in a group of N = 10 healthy human subjects and semiquantitatively assessed by three experienced raters. Template quality was compared statistically via worth estimates (WEs) obtained with a log-linear Bradley-Terry model. RESULTS The overall quality of the templates was better for strategies including both susceptibility and T1 w contrast (MULTI: WE = 0.62; HYBRID: WE = 0.21), but the best method depended on the anatomical region of interest. While methods using only one modality resulted in lower WEs, lowest overall WEs were obtained when only T1 w images were used (DIRECT: WE = 0.12; U-CONV: WE = 0.05). CONCLUSION Template generation strategies that employ only magnetic susceptibility contrast or both magnetic susceptibility and T1 w contrast produce templates with the highest quality. The optimal approach depends on the anatomical structures of interest. The established approach of using only T1 w images (CONV) results in reduced image quality compared to all other approaches studied. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2017;46:1474-1484.
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Affiliation(s)
- Jannis Hanspach
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Niels P Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.,Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy
| | - Xiang Feng
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich Schiller University Jena, Jena, TH, Germany
| | - Jesper Hagemeier
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Nicola Bertolino
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Paul Polak
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Jürgen R Reichenbach
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich Schiller University Jena, Jena, TH, Germany.,Michael Stifel Center for Data-driven and Simulation Science Jena, Friedrich Schiller University Jena, Jena, TH, Germany
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.,MRI Clinical and Translational Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Ferdinand Schweser
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.,MRI Clinical and Translational Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
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30
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Kalpouzos G, Garzón B, Sitnikov R, Heiland C, Salami A, Persson J, Bäckman L. Higher Striatal Iron Concentration is Linked to Frontostriatal Underactivation and Poorer Memory in Normal Aging. Cereb Cortex 2017; 27:3427-3436. [DOI: 10.1093/cercor/bhx045] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Indexed: 12/12/2022] Open
Affiliation(s)
- Grégoria Kalpouzos
- Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Benjamín Garzón
- Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Rouslan Sitnikov
- MRI Research Center, Karolinska University Hospital, Stockholm, Sweden
| | - Carmel Heiland
- Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Alireza Salami
- Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Umeå Center for Functional Brain Imaging (UFBI), Umeå University, Umeå, Sweden
- Department of Integrative Medical Biology, Physiology Section, Umeå University, Umeå, Sweden
| | - Jonas Persson
- Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Lars Bäckman
- Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden
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Caporale A, Palombo M, Macaluso E, Guerreri M, Bozzali M, Capuani S. The γ-parameter of anomalous diffusion quantified in human brain by MRI depends on local magnetic susceptibility differences. Neuroimage 2016; 147:619-631. [PMID: 28011255 DOI: 10.1016/j.neuroimage.2016.12.051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/22/2016] [Accepted: 12/19/2016] [Indexed: 12/15/2022] Open
Abstract
Motivated by previous results obtained in vitro, we investigated the dependence of the anomalous diffusion (AD) MRI technique on local magnetic susceptibility differences (Δχ) driven by magnetic field inhomogeneity in human brains. The AD-imaging contrast investigated here is quantified by the stretched-exponential parameter γ, extracted from diffusion weighted (DW) data collected by varying diffusion gradient strengths. We performed T2* and DW experiments in eight healthy subjects at 3.0T. T2*-weighted images at different TEs=(10,20,35,55)ms and DW-EPI images with fourteen b-values from 0 to 5000s/mm2 were acquired. AD-metrics and Diffusion Tensor Imaging (DTI) parameters were compared and correlated to R2* and to Δχ values taken from literature for the gray (GM) and the white (WM) matter. Pearson's correlation test and Analysis of Variance with Bonferroni post-hoc test were used. Significant strong linear correlations were found between AD γ-metrics and R2* in both GM and WM of the human brain, but not between DTI-metrics and R2*. Depending on Δχ driven magnetic field inhomogeneity, the new contrast provided by AD-γ imaging reflects Δχ due to differences in myelin orientation and iron content within selected regions in the WM and GM, respectively. This feature of the AD-γ imaging due to the fact that γ is quantified by using MRI, may be an alternative strategy to investigate, at high magnetic fields, microstructural changes in myelin, and alterations due to iron accumulation. Possible clinical applications might be in the field of neurodegenerative diseases.
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Affiliation(s)
- A Caporale
- Morpho-functional Sciences, Department of Anatomical, Histological, Forensic and of the Locomotor System Science, Sapienza University of Rome, Italy; CNR ISC UOS Roma Sapienza, Physics Department Sapienza University of Rome, Rome, Italy.
| | - M Palombo
- CNR ISC UOS Roma Sapienza, Physics Department Sapienza University of Rome, Rome, Italy; MIRCen, CEA/DSV/I(2)BM, Fontenay-aux-Roses, France
| | - E Macaluso
- ImpAct Team, Lyon Neuroscience Research Center, Lyon, France
| | - M Guerreri
- CNR ISC UOS Roma Sapienza, Physics Department Sapienza University of Rome, Rome, Italy; Morphogenesis & Tissue Engineering, Department of Anatomical, Histological, Forensic and of the Locomotor System Science, Sapienza University of Rome, Italy
| | - M Bozzali
- Neuroimaging Laboratory Santa Lucia Foundation, Rome, Italy
| | - S Capuani
- CNR ISC UOS Roma Sapienza, Physics Department Sapienza University of Rome, Rome, Italy
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Chen L, Cai C, Yang T, Lin J, Cai S, Zhang J, Chen Z. Changes in brain iron concentration after exposure to high-altitude hypoxia measured by quantitative susceptibility mapping. Neuroimage 2016; 147:488-499. [PMID: 27986608 DOI: 10.1016/j.neuroimage.2016.12.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 12/11/2016] [Accepted: 12/13/2016] [Indexed: 01/20/2023] Open
Abstract
Hypoxia can induce physiological changes. This study aims to explore effects of high-altitude (HA) hypoxia on cerebral iron concentration. Twenty-nine healthy sea-level participants were tested shortly before and after approximately 4-week adaptation to the HA environment at fQinghai-Tibet Plateau (4200m), and were re-investigated after re-adaptation to the sea-level environment one year later. Iron concentration was quantified with quantitative susceptibility mapping (QSM), and the results were compared with transverse relaxation rate (R*2) measurements. The variations of magnetic susceptibility indicate that the iron concentration in gray matter regions, especially in basal ganglia, including caudate nucleus, putamen, globus pallidus and substantia nigra, increases significantly after HA exposure. This increase appears consistent with the conclusion from R*2 value variations. However, unlike QSM, the R*2 value fails to demonstrate the statistical difference of iron content in red nucleus. The re-investigation results show that most variations are recovered after sea-level re-adaptation for one year. Additionally, hemisphere- and gender-related differences in iron concentration changes were analyzed among cerebral regions. The results show greater possibilities in the right hemisphere and females. Further studies based on diffusion tensor imaging (DTI) suggest that the fractional anisotropy increases and the mean diffusivity decreases after HA exposure in six deep gray matter nuclei, with linear dependence on iron concentration only in putamen. In conclusion, the magnetic susceptibility value can serve as a quantitative marker of brain iron, and variations of regional susceptibility reported herein indicate that HA hypoxia can result in significant iron deposition in most deep gray matter regions. Additionally, the linear dependence of DTI metrics on iron concentration in putamen indicates a potential relationship between ferritin and water diffusion.
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Affiliation(s)
- Lin Chen
- Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Xiamen University, Xiamen 361005, China
| | - Congbo Cai
- Department of Communication Engineering, Xiamen University, Xiamen 361005, China
| | - Tianhe Yang
- Magnetic Resonance Center, Zhongshan Hospital, Medical College of Xiamen University, Xiamen 361004, China
| | - Jianzhong Lin
- Magnetic Resonance Center, Zhongshan Hospital, Medical College of Xiamen University, Xiamen 361004, China
| | - Shuhui Cai
- Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Xiamen University, Xiamen 361005, China.
| | - Jiaxing Zhang
- Department of Physiology and Neurobiology, Medical College of Xiamen University, Xiamen 361102, China.
| | - Zhong Chen
- Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Xiamen University, Xiamen 361005, China
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Dusek P, Schneider SA, Aaseth J. Iron chelation in the treatment of neurodegenerative diseases. J Trace Elem Med Biol 2016; 38:81-92. [PMID: 27033472 DOI: 10.1016/j.jtemb.2016.03.010] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 01/14/2023]
Abstract
Disturbance of cerebral iron regulation is almost universal in neurodegenerative disorders. There is a growing body of evidence that increased iron deposits may contribute to degenerative changes. Thus, the effect of iron chelation therapy has been investigated in many neurological disorders including rare genetic syndromes with neurodegeneration with brain iron accumulation as well as common sporadic disorders such as Parkinson's disease, Alzheimer's disease, and multiple sclerosis. This review summarizes recent advances in understanding the role of iron in the etiology of neurodegeneration. Outcomes of studies investigating the effect of iron chelation therapy in neurodegenerative disorders are systematically presented in tables. Iron chelators, particularly the blood brain barrier-crossing compound deferiprone, are capable of decreasing cerebral iron in areas with abnormally high concentrations as documented by MRI. Yet, currently, there is no compelling evidence of the clinical effect of iron removal therapy on any neurological disorder. However, several studies indicate that it may prevent or slow down disease progression of several disorders such as aceruloplasminemia, pantothenate kinase-associated neurodegeneration or Parkinson's disease.
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Affiliation(s)
- Petr Dusek
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital in Prague, Czech Republic; Institute of Neuroradiology, University Göttingen, Göttingen, Germany.
| | | | - Jan Aaseth
- Innlandet Hospital Trust, Kongsvinger, Norway; Hedmark University College, Elverum, Norway
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Guan X, Xuan M, Gu Q, Xu X, Huang P, Wang N, Shen Z, Xu J, Luo W, Zhang M. Influence of regional iron on the motor impairments of Parkinson's disease: A quantitative susceptibility mapping study. J Magn Reson Imaging 2016; 45:1335-1342. [PMID: 27545971 DOI: 10.1002/jmri.25434] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 08/05/2016] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Because the roles of striatal-thalamo-cortical and cerebello-thalamo-cortical circuits in the heterogeneous motor impairments of Parkinson's disease (PD) are becoming recognized, this study was designed to investigate the relationships between regional iron in the cardinal subcortical nuclei in these circuits and the different motor impairments. MATERIALS AND METHODS Sixty-two PD patients and 40 normal subjects were included and accepted for Enhanced T2 -Star Weighted Angiography Scanning (3.0T). According to the Unified Parkinson's Disease Rating Scale, patients were divided into tremor-dominant (PD-TD) and akinetic/rigid-dominant groups (PD-AR). The intergroup differences of magnetic susceptibility in those cardinal nuclei were measured. Correlation analyses between magnetic susceptibility and motor impairments were performed in all patients. RESULTS Nigral magnetic susceptibility significantly increased for each PD group compared with controls (P < 0.001 for PD-TD; P = 0.001 for PD-AR). Magnetic susceptibility in the dentate nucleus (DN) and red nucleus (RN) for the PD-TD patients were significantly increased compared with controls (P < 0.001 and P = 0.004, respectively). Magnetic susceptibility in these regions was also significantly correlated with tremor severity (r = 0.444, P = 0.001 for DN; r = 0.418, P = 0.001 for RN). Significant correlation between caudate magnetic susceptibility and akinetic/rigid severity were observed (r = -0.322, P = 0.015). CONCLUSION This study provides evidence that nigral iron accumulation is a common characteristic in PD, while iron accumulation in the DN and RN is correlated with tremor symptoms. Our data also indicate that caudate iron content may be a potential marker for akinetic/rigid progression. LEVEL OF EVIDENCE 3 J. MAGN. RESON. IMAGING 2017;45:1335-1342.
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Affiliation(s)
- Xiaojun Guan
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Min Xuan
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Quanquan Gu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaojun Xu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Peiyu Huang
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Nian Wang
- Brain Imaging and Analysis Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Zhujing Shen
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingjing Xu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Luo
- Department of Neurology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Minming Zhang
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Straub S, Schneider TM, Emmerich J, Freitag MT, Ziener CH, Schlemmer HP, Ladd ME, Laun FB. Suitable reference tissues for quantitative susceptibility mapping of the brain. Magn Reson Med 2016; 78:204-214. [DOI: 10.1002/mrm.26369] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 06/24/2016] [Accepted: 07/13/2016] [Indexed: 01/22/2023]
Affiliation(s)
- Sina Straub
- Department of Medical Physics in Radiology; German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Till M. Schneider
- Department of Neuroradiology; University of Heidelberg; Heidelberg Germany
- Department of Radiology; German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Julian Emmerich
- Department of Medical Physics in Radiology; German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Martin T. Freitag
- Department of Radiology; German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Christian H. Ziener
- Department of Radiology; German Cancer Research Center (DKFZ); Heidelberg Germany
| | | | - Mark E. Ladd
- Department of Medical Physics in Radiology; German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Frederik B. Laun
- Department of Medical Physics in Radiology; German Cancer Research Center (DKFZ); Heidelberg Germany
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36
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Betts MJ, Acosta-Cabronero J, Cardenas-Blanco A, Nestor PJ, Düzel E. High-resolution characterisation of the aging brain using simultaneous quantitative susceptibility mapping (QSM) and R2* measurements at 7T. Neuroimage 2016; 138:43-63. [PMID: 27181761 DOI: 10.1016/j.neuroimage.2016.05.024] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 04/28/2016] [Accepted: 05/07/2016] [Indexed: 12/12/2022] Open
Abstract
Quantitative susceptibility mapping (QSM) has recently emerged as a novel magnetic resonance imaging (MRI) method to detect non-haem iron deposition, calcifications, demyelination and vascular lesions in the brain. It has been suggested that QSM is more sensitive than the more conventional quantifiable MRI measure, namely the transverse relaxation rate, R2*. Here, we conducted the first high-resolution, whole-brain, simultaneously acquired, comparative study of the two techniques using 7Tesla MRI. We asked which of the two techniques would be more sensitive to explore global differences in tissue composition in elderly adults relative to young subjects. Both QSM and R2* revealed strong age-related differences in subcortical regions, hippocampus and cortical grey matter, particularly in superior frontal regions, motor/premotor cortices, insula and cerebellar regions. Within the basal ganglia system-but also hippocampus and cerebellar dentate nucleus-, QSM was largely in agreement with R2* with the exception of the globus pallidus. QSM, however, provided superior anatomical contrast and revealed age-related differences in the thalamus and in white matter, which were otherwise largely undetected by R2* measurements. In contrast, in occipital cortex, age-related differences were much greater with R2* compared to QSM. The present study, therefore, demonstrated that in vivo QSM using ultra-high field MRI provides a novel means to characterise age-related differences in the human brain, but also combining QSM and R2* using multi-gradient recalled echo imaging can potentially provide a more complete picture of mineralisation, demyelination and/or vascular alterations in aging and disease.
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Affiliation(s)
- Matthew J Betts
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany.
| | | | - Arturo Cardenas-Blanco
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany; Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Peter J Nestor
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Emrah Düzel
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany; Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; Institute of Cognitive Neuroscience, University College London, 17 Queen Square, London WC1N 3AR, UK
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37
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Carpenter KLH, Li W, Wei H, Wu B, Xiao X, Liu C, Worley G, Egger HL. Magnetic susceptibility of brain iron is associated with childhood spatial IQ. Neuroimage 2016; 132:167-174. [PMID: 26899787 DOI: 10.1016/j.neuroimage.2016.02.028] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 01/23/2016] [Accepted: 02/09/2016] [Indexed: 02/09/2023] Open
Abstract
Iron is an essential micronutrient for healthy brain function and development. Because of the importance of iron in the brain, iron deficiency results in widespread and lasting effects on behavior and cognition. We measured iron in the basal ganglia of young children using a novel MRI method, quantitative susceptibility mapping, and examined the association of brain iron with age and cognitive performance. Participants were a community sample of 39 young children recruited from pediatric primary care who were participating in a 5-year longitudinal study of child brain development and anxiety disorders. The children were ages 7 to 11years old (mean age: 9.5years old) at the time of the quantitative susceptibility mapping scan. The differential abilities scale was administered when the children were 6years old to provide a measure of general intelligence and verbal (receptive and expressive), non-verbal, and spatial performance. Magnetic susceptibility values, which are linearly related to iron concentration in iron-rich areas, were extracted from regions of interest within iron-rich deep gray matter nuclei from the basal ganglia, including the caudate, putamen, substantia nigra, globus pallidus, and thalamus. Controlling for scan age, there was a significant positive association between iron in the basal ganglia and spatial IQ, with this effect being driven by iron in the right caudate We also replicated previous findings of a significant positive association between iron in the bilateral basal ganglia and age. Our finding of a positive association between spatial IQ and mean iron in the basal ganglia, and in the caudate specifically, suggests that iron content in specific regions of the iron-rich deep nuclei of the basal ganglia influences spatial intelligence. This provides a potential neurobiological mechanism linking deficits in spatial abilities reported in children who were severely iron deficient as infants to decreased iron within the caudate.
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Affiliation(s)
- Kimberly L H Carpenter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
| | - Wei Li
- Research Imaging Institute, University of Texas Health Science Center, San Antonio, TX, USA; Department of Ophthalmology, University of Texas Health Science Center, San Antonio, TX, USA; Brain Imaging and Analysis Center, Duke University School of Medicine, Durham, NC, USA
| | - Hongjiang Wei
- Brain Imaging and Analysis Center, Duke University School of Medicine, Durham, NC, USA
| | - Bing Wu
- Brain Imaging and Analysis Center, Duke University School of Medicine, Durham, NC, USA; GE Healthcare, Beijing, China
| | - Xue Xiao
- Brain Imaging and Analysis Center, Duke University School of Medicine, Durham, NC, USA; Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Chunlei Liu
- Brain Imaging and Analysis Center, Duke University School of Medicine, Durham, NC, USA; Department of Radiology, Duke University School of Medicine, Durham, NC, USA
| | - Gordon Worley
- Program in Neurodevelopmental Disabilities, Division of Pediatric Neurology, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Helen Link Egger
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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38
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Eylers VV, Maudsley AA, Bronzlik P, Dellani PR, Lanfermann H, Ding XQ. Detection of Normal Aging Effects on Human Brain Metabolite Concentrations and Microstructure with Whole-Brain MR Spectroscopic Imaging and Quantitative MR Imaging. AJNR Am J Neuroradiol 2015; 37:447-54. [PMID: 26564440 DOI: 10.3174/ajnr.a4557] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 07/26/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND PURPOSE Knowledge of age-related physiological changes in the human brain is a prerequisite to identify neurodegenerative diseases. Therefore, in this study whole-brain (1)H-MRS was used in combination with quantitative MR imaging to study the effects of normal aging on healthy human brain metabolites and microstructure. MATERIALS AND METHODS Sixty healthy volunteers, 21-70 years of age, were studied. Brain maps of the metabolites NAA, creatine and phosphocreatine, and Cho and the tissue irreversible and reversible transverse relaxation times T2 and T2' were derived from the datasets. The relative metabolite concentrations and the values of relaxation times were measured with ROIs placed within the frontal and parietal WM, centrum semiovale, splenium of the corpus callosum, hand motor area, occipital GM, putamen, thalamus, pons ventral/dorsal, and cerebellar white matter and posterior lobe. Linear regression analysis and Pearson correlation tests were used to analyze the data. RESULTS Aging resulted in decreased NAA concentrations in the occipital GM, putamen, splenium of the corpus callosum, and pons ventral and decreased creatine and phosphocreatine concentrations in the pons dorsal and putamen. Cho concentrations did not change significantly in selected brain regions. T2 increased in the cerebellar white matter and decreased in the splenium of the corpus callosum with aging, while the T2' decreased in the occipital GM, hand motor area, and putamen, and increased in the splenium of the corpus callosum. Correlations were found between NAA concentrations and T2' in the occipital GM and putamen and between creatine and phosphocreatine concentrations and T2' in the putamen. CONCLUSIONS The effects of normal aging on brain metabolites and microstructure are region-dependent. Correlations between both processes are evident in the gray matter. The obtained data could be used as references for future studies on patients.
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Affiliation(s)
- V V Eylers
- From the Institute of Diagnostic and Interventional Neuroradiology (V.V.E., P.B., P.R.D., H.L., X.-Q.D.), Hannover Medical School, Hannover, Germany
| | - A A Maudsley
- Department of Radiology (A.A.M.), University of Miami School of Medicine, Miami, Florida
| | - P Bronzlik
- From the Institute of Diagnostic and Interventional Neuroradiology (V.V.E., P.B., P.R.D., H.L., X.-Q.D.), Hannover Medical School, Hannover, Germany
| | - P R Dellani
- From the Institute of Diagnostic and Interventional Neuroradiology (V.V.E., P.B., P.R.D., H.L., X.-Q.D.), Hannover Medical School, Hannover, Germany
| | - H Lanfermann
- From the Institute of Diagnostic and Interventional Neuroradiology (V.V.E., P.B., P.R.D., H.L., X.-Q.D.), Hannover Medical School, Hannover, Germany
| | - X-Q Ding
- From the Institute of Diagnostic and Interventional Neuroradiology (V.V.E., P.B., P.R.D., H.L., X.-Q.D.), Hannover Medical School, Hannover, Germany
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39
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Liu C, Wei H, Gong NJ, Cronin M, Dibb R, Decker K. Quantitative Susceptibility Mapping: Contrast Mechanisms and Clinical Applications. ACTA ACUST UNITED AC 2015; 1:3-17. [PMID: 26844301 PMCID: PMC4734903 DOI: 10.18383/j.tom.2015.00136] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Quantitative susceptibility mapping (QSM) is a recently developed magnetic resonance imaging (MRI) technique for quantifying the spatial distribution of magnetic susceptibility within biological tissues. It first uses the frequency shift in the MRI signal to map the magnetic field profile within the tissue. The resulting field map is then used to determine the spatial distribution of the underlying magnetic susceptibility by solving an inverse problem. The solution is achieved by deconvolving the field map with a dipole field, under the assumption that the magnetic field results from a superposition of the dipole fields generated by all voxels and that each voxel has its own unique magnetic susceptibility. QSM provides an improved contrast-to-noise ratio for certain tissues and structures compared with its magnitude counterpart. More importantly, magnetic susceptibility directly reflects the molecular composition and cellular architecture of the tissue. Consequently, by quantifying magnetic susceptibility, QSM is becoming a quantitative imaging approach for characterizing normal and pathological tissue properties. This article reviews the mechanism that generates susceptibility contrast within tissues and some associated applications.
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Affiliation(s)
- Chunlei Liu
- Brain Imaging and Analysis Center, Duke University School of Medicine, Durham, NC 27710; Department of Radiology, Duke University School of Medicine, Durham, NC 27710; Center for In Vivo Microscopy, Duke University School of Medicine, Durham, NC 27710
| | - Hongjiang Wei
- Brain Imaging and Analysis Center, Duke University School of Medicine, Durham, NC 27710
| | - Nan-Jie Gong
- Brain Imaging and Analysis Center, Duke University School of Medicine, Durham, NC 27710
| | - Matthew Cronin
- Brain Imaging and Analysis Center, Duke University School of Medicine, Durham, NC 27710
| | - Russel Dibb
- Center for In Vivo Microscopy, Duke University School of Medicine, Durham, NC 27710
| | - Kyle Decker
- Center for In Vivo Microscopy, Duke University School of Medicine, Durham, NC 27710
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40
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He N, Ling H, Ding B, Huang J, Zhang Y, Zhang Z, Liu C, Chen K, Yan F. Region-specific disturbed iron distribution in early idiopathic Parkinson's disease measured by quantitative susceptibility mapping. Hum Brain Mapp 2015; 36:4407-20. [PMID: 26249218 DOI: 10.1002/hbm.22928] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 07/13/2015] [Accepted: 07/23/2015] [Indexed: 02/06/2023] Open
Abstract
In Parkinson's disease (PD), iron elevation in specific brain regions as well as selective loss of dopaminergic neurons is a major pathologic feature. A reliable quantitative measure of iron deposition is a potential biomarker for PD and may contribute to the investigation of iron-mediated PD. The primary purpose of this study is to assess iron variations in multiple deep grey matter nuclei in early PD with a novel MRI technique, quantitative susceptibility mapping (QSM). The inter-group differences of susceptibility and R2* value in deep grey matter nuclei, namely head of caudate nucleus (CN), putamen (PUT), global pallidus (GP), substantia nigra (SN), and red nucleus (RN), and the correlations between regional iron deposition and the clinical features were explored in forty-four early PD patients and 35 gender and age-matched healthy controls. Susceptibility values were found to be elevated within bilateral SN and RN contralateral to the most affected limb in early PD compared with healthy controls (HCs). The finding of increased susceptibility in bilateral SN is consistent with work on a subgroup of patients at the earliest clinical detectable state (Hoehn and Yahr [1967]: Neurology 17:427-442; Stage I). However, increased R2* values were only seen within SN contralateral to the most affected limb in the PD group when compared with controls. Furthermore, bilateral SN magnetic susceptibility positively correlated with disease duration and UPDRS-III scores in early PD. This finding supports the potential value of QSM as a non-invasive quantitative biomarker of early PD.
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Affiliation(s)
- Naying He
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huawei Ling
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bei Ding
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Juan Huang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Zhang
- MR Research, GE Healthcare, Shanghai, China
| | | | - Chunlei Liu
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina.,Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Kemin Chen
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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